HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO'MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _ & ?,019
W�� 1 Permit Number:
Building Permit Application
Planning and Development Services /
Building and code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: Q n /,Li
Legal Description:
3
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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WA (o Kul ktz.
cON�tRUCnON;INFORMATION: (Ii
UHVAC "Gas Tank "Gas
[]Electric El Plumbing OSpr
Total Sq. Ft of Construction4000-00
:l
Cost of Construction: $ �1 0 0 0. 0 0
Piping
ers "Generator
Sq. Ft. of First Floor: _
Utilities: 05ewer Septic
Windows/Doors
Roof = Roof pitch
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name su2a, ne
Name: tI „�
Company: 0�'IQT W��1� (rlls4 wX
Address:�5%_� f7�'Q, coyit
City: State: R,
Zip Code: 3 i//�1�J. Fax:
Phone No.191q-3(J%-.5025
Addresss: 5 m% & fnJ
_
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City:
Zip Code: 305I
Phone Nlo.77� -- I'i�Dl-��rl`41
State:
I' Fax:_I a;-4(Q(-Ti� -7
E-Mail:_H IA
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E -Mail: � utp� �,C {J, �(jkm.
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State or County License:
CkN l $ lB ( ,
IT value at construction is $2501) or more, a RECORDED Notice of commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
The forgoing instrument was acknowledged before me
this () day of � 117i(R Aa � , 20� by
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Produced
Address:
City:
(Signat r of Nota P c- State of Florida }
City:
, -State of F((�ur''i'da
Commi ion`eF% CHRISTINE J. CONWEI}Qat,ANGROVE
Zip: Phone:
'• Commis=ion # GG 017839
Zip: Phone:
My Comm. Expires Aug21, 2020
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced poor to the issuance of a permit.
St Lucie County makes no representation that is granting a permit will authorize thepermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure_ Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, l do hereby agree that I will, in all respects, perform the work
in accordance With the approved plans, the Florida Budding Codes and St Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Rev. 8/2/17
Signature of Owner/ Lessee/Contracto s Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
�
STATE OF FLORIDA
COUNTYof
wuNTYof
The for oing instrument was acknowledged before me
this a day of 'r?�AG,r �_ .20 Lq by
The forgoing instrument was acknowledged before me
this () day of � 117i(R Aa � , 20� by
R(cha f F 2081[&
is k( 60'Q(e_
Name of person king statement
Name of persog/makittg statement
Personally Known V OR Produced Identification
Personalty Known V OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of N ry Public- State of Florida)
(Signat r of Nota P c- State of Florida }
Commi n (jIW�,,, runrSnur J. CON �.
1'µr aper,
, -State of F((�ur''i'da
Commi ion`eF% CHRISTINE J. CONWEI}Qat,ANGROVE
r° `�•, Notary Public. State oI Florida
'• Commis=ion # GG 017839
' - Commission • GG 017839
�••,�,FO,
My Comm. Expires Aug21, 2020
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PERVISOR
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DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17